New Leadership at HHS and ONC: A Change in Direction or Doubling Down?

The greatest indicators of a sea change at Health and Human Services are the selections for the two top jobs in that department: the new Health and Human Services Secretary and the new National Coordinator for Health Information Technology. Both women bring substantive and substantial resumes to the job, which begs the question if their appointments signal a change in direction or a doubling down on the tasks at hand.

At first blush, with only a few weeks of actions to make that judgment call, I’m inclined to think the answer is “both”.

Roll-Your-Sleeves-Up-and-Get-Her-Done Kinda Women

Their resumes indicate that they have a history of getting things done…right…with both hands on the wheel.

That would indicate a change in direction I style for both directions where leadership has been more about tone. It would also indicate a doubling down on the current direction in substance because both women have a history of success in similar roles with a demonstrated ability to overcome obstacles and move things along.

HHS Secretary Sylvia Mathews Burwell

President Obama’s first HHS Secretary, Kathleen Sebelius, as a former governor was a very accomplished politician and leader. In other times, those would be stellar qualifications for the job. In these difficult times, the job calls for a different skill set. Sylvia Mathews Burwell brings that “something more” to the table. She has a distinguished background in healthcare, including a stint as COO for the Gates Foundation, an organization which is probably doing more than any other on the planet to advance global health. Burwell knows healthcare delivery in the most difficult environments, and we need that at the top right now.

I have done a little work in global health, and vaccines in particular, including some work with the Gates Foundation’s pediatric dengue fever International Vaccine Institute during its inception. The issues are highly complex with regional variations in both availability and quality of healthcare infrastructure confounded by a panoply of political and social sensitivities in each country. If she can run that, she can run anything.

ONC Chief Dr. Karen DeSalvo

When former ONC chief Dr. Farzad Mostashari stepped down last fall, it appeared to be a step backwards for national health IT leadership. He was charismatic and passionate, a great voice for the promotion of health IT. Health IT needed a cheerleader, and he was it.

Now that the promotional phase is over, it is time to dig into the details. In addition to her M.D., Dr. DeSalvo has a Master’s in Public Health and her accomplishments center around working with the impoverished in New Orleans as an internist at Tulane University in the aftermath of Katrina. She understands healthcare problems from the ground, but she also has solved them at a systemic level during her time in The Big Easy. She is credited with leading the effort to transform public health from an outmoded system to a modern one, and has experience instituting successful information technology as part of a total system transformation.

I only needed to read an article this morning from a HealthData Management report to see that her experience is already transforming the national health IT effort from the top by coordinating the policy and standards groups. In part, the article said:

Earlier this month, Karen DeSalvo, M.D., National Coordinator for Health IT, announced changes to the Health IT Policy Committee “somewhat siloed” workgroup structure. In an April 8 meeting of the HIT Policy Committee, she called for revisions to the names and scope of the workgroups so that they are more “strategic and forward-thinking” with the restructuring slated to begin in May for a couple of the workgroups and the rest of the transition continuing this summer…In Thursday’s Health IT Standards Committee meeting, DeSalvo announced that outgoing committee chair Jonathan Perlin, M.D., president-elect of the American Hospital Association, will be replaced by Jacob Reider, M.D., ONC’s deputy national coordinator. She said that under Reider’s leadership the HIT Standards Committee will “mirror” the structure of the HIT Policy Committee where ONC is chair but the vice chair, John Halamka, M.D., CIO at Beth Israel Deaconess Medical Center in Boston, will retain his role running meetings.

“That will, I hope, keep the Standards Committee very tethered to the work of Policy [Committee] and ONC,” De Salvo said.

Leadership and Management

In periods of relative calm, leadership can be largely titular. These are not those times. While Burwell’s and DeSalvo’s predecessors were both stellar leaders in their own right, these times call for operational excellence. That requires hands-on leadership with proven management skills.

With only several weeks’ experience to judge them, it appears the country is getting what it needs right now: a change in direction of the kind of leadership that will double down on moving along all the initiatives to coordinate the implementation of health IT within the larger implementation of the Affordable Care Act.

Wouldn’t you love to be a fly on the wall when these two powerhouses go to lunch to talk about it?

Next Week: Looking at ECRI’s research on the Top 10 Health Information Hazards


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